Sludge is calcium bilirubinate associated with bile stasis

Allen, Bruce G.; Bernhoft, Robin A.; Blanckaert, Norbert; Svanvik, Joar; Filly, Roy A.; Gooding, Gretchen A. W.; Way, Lawrence W.

doi:10.1016/0002-9610(81)90011-8

Cited by 122 publications

(38 citation statements)

References 15 publications

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“…1) of bile pigments in the gallstone matrix confirmed previous observations (8,9) that bilirubin was the major pigment in cholesterol gallstones. The relative amounts of bilirubin, bilirubin monoglucuronides, and bilirubin diglucuronide in gallstone matrix was remarkably similar to the distribution of bilirubin and bilirubin conjugates reported in biliary sludge (15). The close similarity of bile pigment composition in sludge and matrix gives further support to the speculation that biliary sludge is a precursor of gallstones (4), and may serve as the nidus for cholesterol crystal nucleation and gallstone formation.…”

Section: Discussionsupporting

confidence: 71%

“…Our results indicate that the cholesterol gallstone matrix contains a macromolecular complex of mucin and bilirubin that has a composition similar to that reported for biliary sludge (15). In addition, we have found that the reducing agents 2-mercaptoethanol (2ME)' and N-acetylcysteine (NAcCys) partially solubilize the gallstone matrix and accelerate the dissolution of cholesterol gallstones by the solvent monooctanoin.…”

Section: Introductionsupporting

confidence: 76%

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Identification of gallbladder mucin-bilirubin complex in human cholesterol gallstone matrix. Effects of reducing agents on in vitro dissolution of matrix and intact gallstones.

Smith¹,

LaMont²

1985

J. Clin. Invest.

102

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IntroductionThe goals of this study were to isolate and characterize the nonlipid matrix of human cholesterol gallstones. The confirmed by its typical buoyant density during ultracentrifugation. The major bile pigments in the matrix were identified as bilirubin (84%) and bilirubin monoglucuronide (15%) by thin-layer chromatography. Because of their ability to solubilize mucin-type glycoproteins, we tested the ability of the reducing agents 2-mercaptoethanol (2ME) and N-acetylcysteine (NAcCys) to solubilize gallstone matrix. Both reducing agents caused a two-to threefold enhancement of matrix dissolution after 4 d compared to aqueous buffer alone (P < 0.01). Sepharose 2B chromatography revealed that 2ME released a high molecular weight mucinbilirubin complex as well as unbound pigment from the insoluble matrix. We also tested the effect of reducing agents on dissolution of matched cholesterol gallstones by monooctanoin, a cholesterol solvent. Both 2ME and NAcCys significantly accelerated gallstone dissolution in monooctanoin. Matched human cholesterol stones (a = 10) incubated for 4 d in monooctanoin plus either 2ME or NAcCys (1 M final concentration) weighed approximately half as much (P < 0.01 for each) as stones incubated in monooctanoin alone. This study describes, for the first time, the isolation of a bilirubin-mucin complex in the insoluble matrix of human cholesterol gallstones.The ability of reducing agents to dissolve the matrix and thereby accelerate gallstone dissolution by monooctanoin in vitro may be relevant to gallstone dissolution in humans.

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Section: Discussionsupporting

confidence: 71%

Section: Introductionsupporting

confidence: 76%

Identification of gallbladder mucin-bilirubin complex in human cholesterol gallstone matrix. Effects of reducing agents on in vitro dissolution of matrix and intact gallstones.

Smith¹,

LaMont²

1985

J. Clin. Invest.

102

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“…When these results are combined, we can assume that, in the early postoperative period, a considerable amount of bile re mains even after the maximal evacuation of the GB. Bile stasis in the GB has long been postulated to facilitate GS formation [3,5,6,9], More recently, an increased inci dence of GB sludge has been reported in patients main tained on long-term intravenous hyperalimentation that could be attributed to a lithogenic change of bile and/or bile stasis due to an altered GB motor function [24,38,39], Further, a possibility for this sludge to evolve into several kinds of GSs, especially into a pigment variety, has been suggested [12,13]. The identification of GSs in 82% of our patients within 5 years after the surgery is in agreement with a relatively short incubation time of 7 months to 5 years [6,19,40,41 ].…”

Section: Discussionmentioning

confidence: 99%

“…Cholecystectomy with palpation of the GB is a popular method [5,7,[9][10][11][12], DIC is another popular method. This tool, however, is apparently not reliable for detecting small GSs, especially in the presence of hepatic dysfunction or malabsorption [23,24].…”

Section: Discussionmentioning

confidence: 99%

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Increased Risk of Gallstones following Curative Gastrectomy for Cancer

et al. 1989

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The incidence of gallstones in patients who had undergone radical gastrectomy for cure of gastric cancer was 4–8 times higher than in the general population. At least two factors seem to be involved in this high incidence: one is complete vagotomy which is inevitable in gastrectomy with lymph node dissection, and the other perioperative hepatic dysfunction. One fourth of these patients with gallstones required cholecystectomy with or without T-tube drainage. The high incidence of gallstones and a rather difficult cholecystectomy we experienced forced us to perform prophylactic cholecystectomy in these gastric cancer patients diagnosed with: cirrhosis or hepatitis; hemophilia or other hematologic disorders, and the cancer lesion involving the aborad part of the stomach.

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